ROBOTIC COLO-RECTAL RESECTION WITH AND WITHOUT THE NEW INTEGRATED TABLE MOTION FOR DA VINCI XI: A CASE MATCHED STUDY

Background: The integrated table motion (ITM) (Trumpf Medical, Ditzingen, Germany) for da Vinci Xi is a new device which comprises a unique operating table wirelessly communicating with the da Vinci Xi surgical system, that enables patients to be repositioned with instruments inside the abdomen and without undocking the robot. Our study aims to compare operative and short-term outcomes of patients who underwent colorectal surgery for cancer with the da Vinci Xi system using the new ITM, versus a control group of patients undergoing the same procedures with the Da Vinci Xi, but without the use of the ITM. Materials and Methods: From December 2015 to October 2016, ten patients underwent robotic colo-rectal resection (6 anterior rectal resection ARR, 1 intersphinteric rectal resection IRS, 2 right colectomy RC, 1 sigmoid resection SIG) for cancer with the use of ITM (Xi-ITM group) at our center. The intraoperative and short-term results were compared, using case-control methodology, with a similar pool of patients who underwent robotic colo-rectal surgery for cancer without the use of the ITM device (Xi-No-ITM group). Post-operative complications were graded using the Clavien-Dindo classification. A propensity scores approach was performed to create 1:2 matched pairs (matching the Xi-ITM subjects to Xi-No-ITM subjects according to BMI, age, gender, ASA score and intervention type) using a caliper method algorithm. Independent t tests and χ2 test (or Fisher’s exact test) were performed to compare different variables between Xi-ITM and Xi-No-ITM groups. Results: There was a significant difference in the two groups in mean overall robotic operative time (227 min in Xi-ITM group versus 297 min in Xi-No-ITM group, p= 0,04). Surgeries were fully robotic in all Xi-ITM cases, while two cases of Xi-No-ITM group were converted to open surgery because of bulky tumors and difficult exposure (0 vs 2, p=NS). Postoperative medical complications, all of grade I or II, were higher in Xi-No-ITM group (1 vs 11, p= 0,024). Conclusions: In our early experience the use of new Integrated Table Motion for da Vinci Xi resulted in a simplification of workflow. The better exposure of operative field and the possibility to change repeatedly the patients position, without undocking the patient side cart or removing instruments, resulted in a reduced overall robotic operative time and could result in a lower conversion rate as well. The lower postoperative medical complications rate could be due to reduced use of extreme positions to gain optimal exposure of operative field, that resulted in a less hemodynamic, respiratory or soft tissue injuries. However, further experience is necessary to confirm our data.